Vaccine Storage and Handling

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Vaccine Storage and Handling
Mary Ivers Vaccines for Children Site Visit
Coordinator North Carolina Immunization Branch
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Objectives

• Understand the basic vaccine handling rules
• Equipment for vaccine storage
• How to order, receive, transport, store and
  handle vaccine
• Storage and handling mishaps
• Importance of a Disaster Recovery Plan
• Importance of Temperature Logs

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Introduction

• Controlling the spread of infectious disease
• Maintaining the cold chain
• Three basic elements
• Equipment
• Personnel
• Standard Operating Procedures

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5 Basic Handling Rules

• 1. Refrigerator keep it in range and plugged in

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5 Basic Handling Rules

• 2. Vaccines keep them cold and store as
  directed in the package insert

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5 Basic Handling Rules

• 3. MMR keep it cold and protected from light

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5 Basic Handling Rules

• 4. Varicella MMR-V keep it frozen and
  protected from light at all times

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5 Basic Handling Rules

• 5. Rotate vaccine stock

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Equipment
Reliable refrigerators and freezers
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Equipment

• Certified and calibrated thermometers

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Equipment

• Check and record temperatures twice a day
• Maintain proper temperatures

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Equipment

• Separate temperature controls

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Equipment
Warning Sign
Plug Guard
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Equipment
Gel Packs in the Freezer
Water Bottles in Refrigerator
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Equipment - Precautions
Refrigerator/Freezer Lock
Clock/plug style
Penny in a cup
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Freezer Equipment

• MMR, Varicella and MMR-V storage
• Maintain temperatures of 5 F or colder
  continuously with an optimum temperature of 0 F
• Separate sealed freezer door

Freezer
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Personnel

• Designated in charge
• Back-up person
• All staff who handle vaccine

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Standard Operating Procedures

• Written procedures
• Train all staff

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Ordering Vaccine

• Maintain adequate inventory
• Varicella and MMR-V shipped from Merck

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Ordering Vaccine

• Hours of clinic
• Alert all staff

Post your vaccine order for everyone to see!
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Temperature Logs - Refrigerator

• Read and record
• First thing in the AM
• Last thing in the PM

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Temperature Logs - Freezer

• Read and record
• First thing in the AM
• Last thing in the PM

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Vaccine Storage
Diluent
Water Bottles
Water Bottles
Diluent
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Vaccine Storage (contd)

• Refrigerator temperatures
• 36 to 46 Fahrenheit (F)
• or
• 2 to 8 Celsius (C)
• Optimum of 40 F (5 C)

36 and 46F (2 and 8 C
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Vaccine Storage (contd)

• Freezer temperatures
• 5 F or colder with optimum of
• 0 F
• or
• (-)15 C or colder with optimum of -20 C
• Separate, sealed, insulated compartment

36 and 46F (2 and 8 C
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Vaccine Storage (contd)

• Thermometer on the same shelf
• Never store in door
• Keep open vials in a tray
• Store by type/expiration date
• Air circulation

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Vaccine Storage (contd)

• Do not store food, sodas, or patient specimens
  with vaccine

X
X
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Vaccine Storage (contd)

• Gel packs along the walls, back, bottom door
• Water bottles in the door drawers

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Vaccine Storage (contd)
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Receiving Vaccine

• Develop and post protocol
• Open vaccine box immediately
• Check invoice against vaccine received

Match invoice to vaccine received
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Receiving Vaccine

• Refrigerate immediately
• Shipment problems???

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Vaccine Handling
Refrigerated Vaccines

• Maintain temperatures between
• 2 C to 8 C or
• 36 F to 46 F
• Optimum is 5 C (40 F)

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Vaccine Handling
Refrigerated Vaccines

• Do not expose to freezing temperatures
• Do not store in direct contact with ice or frozen
  ice packs
• Exposure to temperatures of 0 C (32 F) or below
  will inactivate them.

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Vaccine Handling (contd)

• MMR, Varicella, FluMist and MMR-V Vaccine
  Frozen Vaccine
• Store frozen at -15 C (5 F) or colder until it
  is reconstituted for injection
• Optimum temperature is -20 C (0 F)

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Vaccine Handling (contd)

• Frozen Vaccine
• Store diluents separately at room temperature or
  refrigerator
• Do not reconstitute until ready to administer
• Never freeze reconstituted vaccine

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Vaccine Handling (contd)

• Frozen Vaccine
• Protect from light
• Separate, sealed, insulated compartment
• Penny test

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Vaccine Handling (contd)

• Never leave vaccine out when not in use
• Mishap, store as indicated on the Package Insert
• Do not pre-draw vaccine, draw vaccine at the time
  of administration

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Vaccine Handling (contd)

• Rotate vaccine weekly by expiration date
• Multi-dose products (expiration date) (Package
  Insert)
• Use ice packs to ensure the cold chain is not
  broken when transporting vaccine
• Never use outdated vaccines.

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Vaccine Preventable Diseases

• Tetanus

• Haemophilus influenzae type b (Hib)

• Chickenpox

• Polio

• Whooping Cough

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Transporting Vaccine

• Use insulated container
• Protect vaccines from gel packs
• Keep refrigerated vaccine container in the car
• Put containers with dry ice in the trunk

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Refrigerator Mishaps
Open Door
Unplugged
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Storage and Handling Mishaps

• Report all mishaps
• Do not assume the worst

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Storage and Handling Mishaps

• Record the temperatures
• Transfer vaccine
• Mark Do Not Use

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Disaster Recovery Plan

• Train staff
• Designate person
• List back-up systems
• Post Disaster Recovery Plan

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Disaster Recovery Plan

• Conduct an inventory
• Package vaccine to transport

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Educational Tools

• Immunization Branch web page
• www.immunizenc.com
• Storage and Handling Vaccine Guide
• National Immunization Program http//www.cdc.gov/v
  accines/
• Epidemiology and Prevention of Vaccine
  Preventable Disease 10th Edition (The Pink Book)
• Vaccine Storage and Handling Toolkit
• Vaccine Management - Recommendations for Handling
  and Storage of Selected Bilogicals (January 2007)
• North Carolina Immunization Branch Customer
  Service staff 1-877-873-6247